Evaluating a curriculum map for undergraduate medical education: a critical analysis through different stakeholder lenses

Abstract In 2018, UCL Medical School commissioned a programme ‘Curriculum Map’ (CM). As the project’s lead, I theorised, designed and co-constructed the CM. My adopted theoretical position equated curriculum with syllabus, acknowledging that whilst this reflected the ‘formal’ curriculum, it did not capture the ‘informal’ or ‘hidden’ curricular elements. This doctoral research is a retrospective critical examination of the CM exercise. The professional practice problem addressed was whether the CM was judged by users as being ‘fit for purpose’. To address three research questions, the attitudes of key stakeholders (students and self) were analysed, examining the CM’s perceived purpose and drivers and asking whether it had accurately reflected the whole syllabus, including the professional ‘soft skills’. The role of institutional and national educational metrics in curriculum mapping was examined. An interpretivist paradigm using a novel ‘bricolage’ methodological framework of self-study and hermeneutic phenomenology was used. This blended approach drew on meaning and interpretation of data. Multi-method data collection was used to generate three discrete datasets (autoethnographic data; pan-student primary survey; student focus groups), which were synthesised using reflective thematic analysis. Descriptive statistics were used to analyse limited quantitative data. The findings were triangulated, looking for congruence in overall arguments. Data from stakeholders were synthesised into five themes; power in medical education (metrics drive practice, assessment drives learning); troubling trustworthiness, fairness and social justice; the hidden curriculum of ‘hard over soft’; navigating uncertainty and finding compromise; and building legacy. Different stakeholder lenses brought convergence and divergence to the data. My multiple positionality brought personal (reflexive), professional and political lenses to this ‘insider research’. As other UK medical schools are undertaking CM projects, it is anticipated that this work will have impact for the undergraduate community of practice. It may also have broader relevance in postgraduate medical education and other healthcare disciplines

Medical student perceptions of reflective practice in the undergraduate curriculum [version 1; peer review: awaiting peer review]

INTRODUCTION: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. METHODS: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. RESULTS: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. CONCLUSION: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum

Medical student perceptions of reflective practice in the undergraduate curriculum [version 3; peer review: 1 approved, 1 approved with reservations]

INTRODUCTION: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. METHODS: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. RESULTS: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. CONCLUSION: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum

Evaluating a novel intervention in undergraduate medicine: an MBBS Curriculum Map

Background: Following student feedback, a Curriculum Map (CM) was commissioned in 2018 at UCL Medical School (UCLMS). After exploring key requirements of a CM, the second phase focused on building a prototype before its launch. This study evaluates this novel pedagogical intervention following its implementation, from the perspective of its primary users, UCL medical students. / Methods: This multi-method study was conducted two months after the CM’s launch in 2019. Quantitative and qualitative data was gathered via a survey and focus groups across four domains: usefulness, satisfaction, appearance, and content. Reflective Thematic Analysis was used to analyse the qualitative data to build themes. / Results: One hundred ninety five participants (195/1347, 14%) responded to the survey and two focus groups were held. Higher rates of satisfaction were seen among later years compared to early years students. Five key themes emerged on the CM as a: UCLMS textbook; learning aid for assessments; tool for capturing scientific content; modern learning technology and tool for ‘levelling the playing field’. Key findings suggest that while students welcomed a centralised resource to create transparency, there were clear differences between early and later years students, with the former preferring a more prescriptive approach. Learning was assessment-driven across all years and students highlighted their desire for greater clarity on the importance of curricular content for summative assessments. / Conclusion: A CM provides a benchmark for medical educators on the undergraduate curriculum, which must be balanced with its limitations; a CM cannot provide an exhaustive syllabus and needs to be supplemented with self-directed learning and clinical preparation for practice

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors’ professional behaviours and attitudes towards the regulator

OBJECTIVE: This paper examines the impact on doctors’ attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case. DESIGN: A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case. SETTING: Primary and secondary care settings across a broad geographical spread in England. PARTICIPANTS: 474 doctors. OUTCOME MEASURES: Attitudes towards the GMC and two professional behaviours in TPB dimensions. RESULTS: Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC’s disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors’ attitudes or intention to reflect or raise concerns. CONCLUSIONS: The lack of change in doctors’ attitudes towards the GMC’s guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors’ trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors’ overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism

Schwartz Centre Rounds: a new initiative in the undergraduate curriculum — what do medical students think?

Background: Training to be a doctor and caring for patients are recognized as being stressful and demanding. The wellbeing of healthcare professionals impacts upon the wellbeing and care of patients. Schwartz Centre Rounds (SCRs), multidisciplinary meetings led by a trained facilitator and designed for hospital staff, were introduced to enhance communication and compassion, and have since been widely adopted as a way of fostering compassion. The continuum of education suggests that medical students need to develop these attributes in conjunction with resilience and maintaining empathy. The benefits of SCRs in fostering this development in medical students is unexplored. The objective of this study was to examine the potential of SCRs within the undergraduate curriculum. Methods: Two student–focused SCRs were piloted at a major medical school. The sessions were based on the current format implemented across the US and UK: a presentation of cases by a multidisciplinary panel followed by an open discussion with the audience. Participants were asked to complete an evaluative questionnaire immediately following the sessions. Seven students took part in a focus group to explore their views on the SCR. Data sets were examined using descriptive statistics and thematic analysis. Results: Feedback was obtained from 77 % (258/334) Year 5 and 37 % (126/343) Year 6 students. Mean student ratings of the session on a five-point scale, where 1 = poor and 5 = exceptional, were 3.5 (Year 5) and 3.3 (Year 6). Over 80 % of respondents either agreed or strongly agreed that the presentation of cases was helpful and gave them insight into how others feel/think about caring for patients. Eighty percent said they would attend a future SCR and 64 % believed SCRs should be integrated into the curriculum. Focus group participants felt SCRs promoted reflection and processing of emotion. Students identified smaller group sizes and timing in the curriculum as ways of improving SCRs. Conclusion: Students were positive about SCRs, preferring them to their current reflective practice assignments. Whether this results in sustained benefits to trainee doctors is yet to be explored. Consideration is given to overcoming the challenges that were encountered, such as optimal timing and participation. Staff training and costs are potential obstacles to adoption

Progress and divergence in palliative care education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning.

BACKGROUND: Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown. AIM: To investigate palliative care training at UK medical schools and compare with data collected in 2000. DESIGN: An anonymised, web-based multifactorial questionnaire. SETTINGS/PARTICIPANTS: Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000. RESULTS: All continue to deliver mandatory teaching on 'last days of life, death and bereavement'. Time devoted to palliative care teaching time varied (2000: 6-100 h, mean 20 h; 2013: 7-98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include 'involvement in clinical areas', participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students' assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally. CONCLUSION: Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.This is the author accepted manuscript. The final version is available from Sage Publications via http://dx.doi.org/10.1177/026921631562712

Phylogenetic ctDNA analysis depicts early-stage lung cancer evolution.

The early detection of relapse following primary surgery for non-small-cell lung cancer and the characterization of emerging subclones, which seed metastatic sites, might offer new therapeutic approaches for limiting tumour recurrence. The ability to track the evolutionary dynamics of early-stage lung cancer non-invasively in circulating tumour DNA (ctDNA) has not yet been demonstrated. Here we use a tumour-specific phylogenetic approach to profile the ctDNA of the first 100 TRACERx (Tracking Non-Small-Cell Lung Cancer Evolution Through Therapy (Rx)) study participants, including one patient who was also recruited to the PEACE (Posthumous Evaluation of Advanced Cancer Environment) post-mortem study. We identify independent predictors of ctDNA release and analyse the tumour-volume detection limit. Through blinded profiling of postoperative plasma, we observe evidence of adjuvant chemotherapy resistance and identify patients who are very likely to experience recurrence of their lung cancer. Finally, we show that phylogenetic ctDNA profiling tracks the subclonal nature of lung cancer relapse and metastasis, providing a new approach for ctDNA-driven therapeutic studies